Study Reveals Fragmented Governance Framework and Information Non-transparency Consumer Council Advocates 5 Recommendations to Realise the Full Potential of Telehealth Services

Hong Kong’s ageing population, increasing longevity and growing prevalence of chronic diseases are driving demand for healthcare services. With an increasing call for convenient, affordable and quality healthcare around the world, telehealth has emerged as a rising trend leveraging technological advancements to enhance public access to healthcare services. The COVID-19 outbreak further accelerated the need for virtual, accessible and timely healthcare services as a solution.

“Telehealth”, as defined by the World Health Organization (WHO), refers to the delivery of healthcare services where patients and providers are separated by distance, using information and communication technologies for exchanging information on the diagnosis and treatment of diseases and injuries. While the WHO has advocated a Global Digital Health Strategy since 2018, Hong Kong has adopted a relatively more prudent approach in leveraging telehealth compared with other markets. In the public sector, telehealth services have been provided by the Hospital Authority’s (HA) “HA Go” mobile application since 2021, yet there is an absence of a comprehensive telehealth service providers list for the private sector. To call for integration of telehealth services into health systems and inclusive governance in the face of growing demand for healthcare services, the Consumer Council conducted a study titled “Enhancing Governance in Telehealth: Fostering Consumer Trust and Innovation” (“the Study”) to understand the perception and experience of consumers and medical practitioners and Chinese medicine practitioners (CMPs) (collectively referred to as MPs hereafter unless otherwise specified) on telehealth services; to review trade practices and terms and conditions (T&Cs) of services of the telehealth service providers with an aim to identify potential issues; and to provide recommendations for promoting the sustainable development of telehealth in Hong Kong.

Issues Identified Through a Mixed-method Approach

The Study adopted a mixed-method approach^[1] in examining the “teleconsultation” services provided by MPs in the private sector.

Various fundamental concerns related to telehealth were revealed in the Study, including fragmented and inadequate governance framework; unclear liability between involved parties; and uncertainty in insurance coverage. In terms of trade practices, key issues found included non-transparent and unclear information provision; lack of consumer choices with limited MPs and consultation timeslots; insufficient operational support; as well as privacy and security concerns over telehealth platforms or teleconferencing tools.

With an overarching aim to empower consumers and strengthen safeguards in the use of telehealth services through enhanced governance and market transparency, the Council puts forward 5 recommendations to be adopted progressively as short-, medium-, and long-term measures:

Recommendation 1 – Strengthen Guidance for Appropriate Professions Providing Telehealth Services

From the surveys, 73.7% of surveyed private MPs that had provided teleconsultation continued to provide the service in the post-COVID-19 era and 73.0% surveyed consumers that had used telehealth services revealed that they had used such services more than once. In an effort to support the development of the telehealth industry, the Government and professional medical organisations have been gradually establishing regulatory frameworks/guidelines, which were designed to be broad and generic in nature in the view that telemedicine is still in the developing stage in Hong Kong. In the Study, MPs expressed concerns over the quality and related legal and ethical issues. With limited guidance to all service providers, the responsibilities and liabilities of some service providers were unclear, 4 out of 19 reviewed traders even claimed that the teleconsultation services provided should not perceived as a diagnosis or treatment. In fact, almost all (99.5%) surveyed MPs regarded improvement concerning telehealth services necessary and 66.5% surveyed MPs deemed further guidance important to clearly specify responsibility of each party and protect both MPs and patients.

Besides, with the growing adoption of telehealth in other healthcare professions, as a medium-term measure, relevant professional medical organisations should also develop comprehensive guidelines for relevant professions to follow.

As an overarching direction, the Government is recommended to collaborate with professional medical organisations to consult medical professionals regarding their experience and concerns in the provision of telehealth services, in order to provide more detailed guidance to the MPs and other appropriate healthcare professionals. In this regard, having taken reference from relevant guidelines and measures from other reviewed markets, the Council puts forward a suggested list of items to be included in the guideline, including clinical standards, obligation and liability, disclosure for informed consent, usage of artificial intelligence (AI), etc.

Recommendation 2 – Enhance Governance to Cover Telehealth Platforms and Communication Tools

The surveys revealed that consumers (50.5%) used WhatsApp and Zoom most often for telehealth, while MPs (55.0%) used WhatsApp most often. Both consumers (40.3%) and MPs (42.7%) worried that consultation sessions could be tracked and monitored when using teleconferencing tools, while collection of excessive personal and payment information was another key consumer concern (29.9%). Furthermore, 8 out of 19 reviewed traders had T&Cs for avoiding liability for losses/damages caused by the use of their telehealth services. 1 even claimed that it had no liability for economic losses resulting from platform malfunctions. To foster consumer trust on telehealth services, the Government is recommended to also oversee service providers supporting the practice of telehealth by healthcare professionals (e.g. telehealth platforms), as well as the use of videoconferencing and secure messaging solutions (e.g. teleconferencing tools) for telehealth, as some of these are not even specifically designed for telehealth, and hence may not be suitable for the practice of medicine. 

In the short to medium term, the Council proposes the following options for consideration:

• Voluntary adoption of accreditation: The Government to encourage telehealth platforms/tools to fulfil a set of requirements (e.g. data security and privacy protection) via voluntary accreditation mechanism to enhance safeguard to consumers’ personal information and health data;
• Whitelist of telehealth platforms/tools: Relevant trade associations to establish a whitelist to provide a record of telehealth platforms/tools that meet the relevant standards and requirements (e.g. accessibility, reliability, security, privacy and confidentiality of patient information, etc.). Suggested items to be disclosed on the whitelist include accreditations obtained by the providers, official and authentic link to the videoconferencing and secure messaging solution provider, etc.; and
• Enhancements via binding contracts: In case private healthcare facilities (PHFs) and MPs collaborate with third-party platforms/tools to provide telehealth service, they are encouraged to enter into service agreement with the service provider(s) to bind them in obliging a set of performance standards (e.g. data protection, confidentiality, user support, access control, liability terms).

As a long-term measure, the Council recommends enhancements on the regulatory frameworks by covering all telehealth service providers, given that current regulatory frameworks/guidelines only govern PHFs and MPs among telehealth service providers, but not telehealth platforms operated by non-PHFs and insurance companies.

Recommendation 3 – Promote Market Transparency on Telehealth

The Council’s online research and complaint cases revealed a general lack of transparency in price and service information, including unclear fees, uncertain refund mechanisms, and confusing service information. At the same time, 3 out of the 19 reviewed traders did not have T&Cs available online, while 4 out of the 14 surveyed traders did not have T&Cs at all.  15 out of 19 reviewed traders did not clearly state refund mechanism for situation where the MP deems the patient unsuitable for telehealth.  Moreover, it was observed that 16 out of 19 reviewed traders provided varying scope of information on problems amenable for telehealth, with no common standard, leading to confusion.  In terms of seeking assistance, close to a fifth (17.9%) of consumers opined that the technical support for using telehealth platforms were insufficient or unclear. Among the Council’s complaint cases concerning telehealth services, non-delivery/refund (such as not being connected to the MP for teleconsultation appointments and the platform’s customer service was unreachable) was the primary cause (57.1%).

Enhancing consumers’ access to information when using telehealth services is essential for empowering patients to make informed decisions, and increase their trust in telehealth platforms. For adoption in the short term, the Council recommends the industry to proactively publicise price related information and enhance the transparency throughout the whole telehealth process:  

• Information provision: Provide clear service charge and operational information (e.g. T&Cs, refund and medication delivery arrangements, problems deemed not amenable to telehealth by the provider);
• Training to staff: Establish internal guidelines or provide training to ensure consumer-facing staff provide patients with necessary and timely information and technical support;
• Advertising: Refrain from exaggeration or false representation in advertisements, as well as unconsented direct marketing; and
• Authentication of identity: Enable authentication of the identity of MPs and patients before consultation (e.g. via iAM Smart).

Recommendation 4 – Improve the Usability of Telehealth Services

The consumer and MP surveys revealed aligned views on the major barriers of using telehealth services, with the inability to conduct physical examination being the biggest apprehension (44.5% consumers; 77% MPs), while concerns over medical incident or inaccurate diagnosis ranked second (27.8% consumers; 41% MPs). Meanwhile, unlike other common outpatient services, whether telehealth is covered by insurance depends on the design of each insurance plan of the company. Such uncertainty in insurance coverage for telehealth services may give rise to consumers’ economic concerns in using the services. The Council recommends adopting a two-pronged approach to improve the usability of telehealth services:

1. Participate in and Contribute to the eHealth System

To enhance diagnostic accuracy against the background of MPs’ infeasibility of physical examination and lack of patient’s medical history, the Council proposes, as an ongoing measure, healthcare providers, medical professionals and the public should be encouraged to participate in the eHealth System for sharing of health records. In light of the low deposit rate of private healthcare providers (as of November 2024, over 99% of the sharable electronic health records on eHealth came from public healthcare providers), it is essential to reinforce data contribution by the private sector, so as to enable citizens receiving seamless care.

2. Expand the Coverage of Insurance to More Telehealth Services

The Council opines that telehealth should be considered by insurance companies when they design new health insurance policies.

In the medium term, insurance companies are recommended to consider covering telehealth by a greater extent of medical insurance policies, so as to reduce patients’ economic concerns in using telehealth services. For existing health insurance policies, insurance reimbursement arrangements should be considered for typical telehealth services, such as teleconsultation, outpatient care, medications, etc., as telehealth services reimbursement should be consistent with in-person services to ensure patients receive equal protection.

Recommendation 5 – Educate and Support Consumers to Safely Use Telehealth Services

The Government has a role in facilitating equitable access to healthcare, including telehealth which may help meet the growing demand for healthcare services, while empowering the public through education is part of that effort. On the other hand, the trade has the responsibility to ensure consumers are well-informed and supported, so as to build consumer trust on their services. According to the Council’s survey, over a third (34.7%) of the surveyed MPs considered patients’ lack of technological know-how a barrier in using teleconsultation.

In the short term, telehealth service providers are recommended to cater to patients with varying levels of digital literacy and diverse needs, by means such as offering essential information in multiple languages and enabling enquiries made through different channels, such as enquiry hotlines.

The Government could provide advice to consumers on fraud prevention, such as advising consumers to clear browsing history and cookies regularly to reduce the risk of being tracked; and to use telehealth service with caution to prevent falling victim to deepfake technology and verify the MP’s identity. Consumers could use the “Scameter” and “Scameter+” launched by the Hong Kong Police Force to assess the risk of fraud and cybersecurity when encountering suspicious URLs, phone numbers and payment accounts.

To be implemented on an ongoing basis, the Government could enhance public understanding on telehealth at district level, and provide education to the public on technological know-how and patient rights when using telehealth, so as to build their self-protection competencies. On the other hand, telehealth service providers should provide clear instructions to patients before using telehealth, especially for vulnerable groups.

Collective Efforts to Realise the Full Potential of Accessible, Quality, Affordable and Sustainable Telehealth Services

Since the COVID-19 pandemic, telehealth has evolved from a niche offering to wider adoption, enabling remote consultations, chronic disease management and health support. The Council considers it essential to adopt a forward-looking approach for Hong Kong to better integrate telehealth into its health systems.

Moreover, as integration between Hong Kong and other cities in the Guangdong-Hong Kong-Macao Greater Bay Area continues to strengthen, the need for cross-boundary telehealth services and data sharing may rise as a result. Meanwhile, various challenges lie ahead, such as digital literacy, infrastructure development, AI advancements, cross-boundary liability, privacy and data issues, presenting hurdles to be overcome.

Through this Study, the Council hopes to raise awareness on the issues and opportunities of telehealth, as well as the enhancements necessary to fully realise its potential for public good. The Council advocates the Government to continue its reform on enhancing the quality and efficiency of healthcare, to also better utilise telehealth and prepare for future advancements step by step in the years to come.

Visit https://www.consumer.org.hk/en/advocacy/study-report/telehealth_services_studyto view the full electronic version of the “Enhancing Governance in Telehealth: Fostering Consumer Trust and Innovation” report.